Almost all cervical cancers (99.7%) are directly related to previous infection by one or more types of HPV (Human Papilloma Virus) that are oncogenic (Judson 1992; Walboomers et al, 1999). Infection occurs after active female sexual activity, usually begins after the age of adolescents (between the ages of 20-30 years) and progression to cervical cancer usually occurs after 10-20 years later, although in rare cases, some types of early lesions can be cancer in a short time within 1-2 years.
It is estimated about 10% of women infected with HPV will have pre-cancerous changes in cervical connective tissue (dysplasia) and 8% of women who undergo pre-cancerous changes will be early cancer confined to the outer layer cells of the cervix (CIS / Carcinoma In Situ), and about 20% of women who experienced CIS will develop into malignant cancer (invasive cancer) when pre-cancerous lesions or CIS are not detected and treated.
Which is a risk factor for cervical Cancer include:
- Sexual activity (age<20 years)
- Multiple sexual partners
- Exposure to IMS
- Mother or sister suffering from cervical cancer
- An abnormal PAP test earlier
- Decreased immunity, which caused suffering from HIV / AIDS or chronic use of corticosteroids (asthma and lupus).
Clinical Symptoms of Cervical Cancer at an early stage is much less pronounced, but the following signs can rely on in determining suspicion of cervical cancer:
- Pain during intercourse,
- Removing a little blood after intercourse,
- Excessive bleeding during menstruation (hypermenorrhea),
- Bleeding outside the menstrual cycle (Polymenorrhea),
- Abnormal vaginal discharge (color is not clear, odor or itching),
- At an advanced stage: no appetite, nausea, back pain, pain and swelling in the thigh, drastic weight loss, constipation, spontaneous bleeding after menopause, brittle bones easily and pelvic pain.
Prevention of cervical cancer can be divided into, as follows:
- Primary prevention, carried out by administering a vaccine is the most effective way to prevent cervical cancer and other genital cancers. Each person needs to be immunized at an early age before they are sexually active. Control Risks is very important (especially the modifiable risk factor) in preventing the chances of developing cervical cancer (cervical cancer).
- Secondary prevention, carried out by early detection of cervical precancerous lesions (as early as possible). Tests of cancer or pre-cancer is recommended for all women aged 30 to 50 years old through IVA test (Visual Inspection Acetic Acid). IVA test can be done at any time in the menstrual cycle, including during menstruation, during pregnancy and post-partum or post-abortion care. IVA test is very important for women who have a risk factor, especially in women suspected of exposure to STIs or HIV / AIDS.
IVA test can be performed in clinics that have the following facilities:
- Desk Check
- Sources of light / lamp
- Bivalved speculum (Cusco or Graves)
- Rack or container equipment.
The light must be strong enough so that the officer can see the end of the vagina where the cervix is. Examination can not be done if there is enough light to see the entire cervix. It is important also kept the light source are not too hot.
The materials required to perform the test IVA must be available on site, including:
- Cotton swab sticks for
- Check out new gloves or surgical gloves that have been in DTT
- Spatula of wood and or condoms
- The liquid solution of 3-5% Acetic Acid (white vinegar can be used)
- 0.5% chlorine solution for decontamination of equipment and gloves
- Notes form to record findings.
Acetic acid is the main ingredient of vinegar. It is recommended to use Acetic Acid with a concentration of 3-5%. Countries are caused no vinegar. Often sold in the market is a substitute for the real vinegar is acetic acid. If vinegar or acetic acid are not available pharmacist or local chemical supplier can dilute acetic acid solution using the formula:
Total Section (TB) Water = (% concentrate : % solution) – 1
Treatment and Follow-up, In most countries with limited resources, Cryotherapy either alone or combined with LEEP (performed at referral centers) is the best choice for outpatient care.
- Effective for small and medium sized lesions (85-95% cure rate)
- Not expensive
- Can be performed by personnel other than physicians
- No need local anesthesia
- No need of electricity
- Few complications / side effects
- It can be done during pregnancy.
Women who test positive IVA (SSK Acetowhite visible lesions), including women with pregnancies less than 20 weeks, should receive cryotherapy treatment, if the lesion:
- Not suspected cancer
- Cervical cover no more than 75%
- Does not extend to the vaginal or cervical canal beyond cryoprob
- Extends no more than 2 mm of diameter prob of cryotherapy including prob end.
If it does not meet the above criteria, the patient should be referred to a health facility is better able to do the inspection and action further therapy (chemotherapy, radiotherapy or surgery).
Cryotherapy can be done in a clinic that has the equipment and facilities as follows:
- Examining table
- Adequate light source
- Speculum Duck (Cusco or Graves)
- Tray or container equipment
- Cryotherapy Unit
- Supply of CO2 or NO2 regular.